1 -----------------------------------------------2 -----------------------------------------------3 -----------------------------------------------5 ----------------------------------------------19 --------------------------------------------------26 ------------------------------------------------26 ------------------------------------------27 --------------------------------------------29 ------------------------------------------------37 --------------------------------------------------41 ----------------------------------------------43 --------------------------------------------------46 --------------------------------------------------48 ----------------------------------------------50 1
2 136 147 11 2 128 42 86 42 LBC 11 LBC 8 28 1. LBC LBC 2. 136 4 RDS <37 1 3. LBC19 1000/ L RDS 100% 98.4% 66.7% 100% 4. LBC 100.3 63.8 1000/ L 84.2 52.2 1000/ L t=-1.268 p=0.208 5. LBC 105.9 78.5 63.3 48.9 1000/ L t=-2.86,p=0.0168 1. LBC 2. 37 3. LBC 2
3 The use of Lamellar body counts to predict fetal lung maturity in pregnancies with abnormal glucose metabolism Objective To evaluate the predictive value of amniotic fluid lamellar body counts in prediction of fetal lung maturity in pregnancies with abnormal glucose metabolism and observe the influence of maternal abnormal glucose metabolism on fetal lung maturity. Materials and methods 147 amniotic fluid obtained from 136 patients who delivered in our hospital were collected from March 2003 to October 2003.Among them amniotic fluid lamellar body counts were tested, 11 patients were tested twice. Neonatal outcomes could be traced in 128 patients who delivered after 28 gestational weeks. 42 of them were patients with abnormal glucose metabolism, the other 86 women with normal glucose metabolism. We compared LBC in amniotic fluid from the two groups, and LBC from the two samples. The sensitivities and specificities of various lamellar body counts cutoff values were calculated with neonatal respiratory distress syndrome. Result (1)lamellar body counts were correlated with gestational age, as the gestational age increased, LBC increased gradually.(2) There were 4 NRDS among the 136 neonates, all gestational age of them were less than 37 weeks. None of them occurred in pregnancies with abnormal glucose metabolism. (3) If the cutoff value of lamellar body counts was less than 19 1000/ L, the sensitivity was 100% specificity was 98.4% positive predictive value was 6.7% and negative predictive value was 100% (4) LBC from women with abnormal glucose metabolism was 100.3 63.8 1000/ L the control group was 84.2 52.2 1000/ L,there was no statistic difference between the two groups t=-1.268 p=0.208 (5) LBC was significantly increased after antenatal corticosteroid therapy for fetal maturation. t=-2.86,p=0.0168 Conclusion 1. The lamellar body count is a valid, rapid screening 3
4 test for the determination of biochemical fetal maturity in pregnancy complicated with abnormal glucose metabolism. 2. In strict glucose controlled patients with abnormal glucose metabolism, FLM is not delayed. If the gestational age is exceeded 37 weeks, the fetal lung maturity should not detect before delivery. 3. LBC increased after antenatal corticosteroid therapy for fetal maturation. Keyword lamellar body count, amniotic fluid, fetal lung maturity, abnormal glucose metabolism, surface active material 4
5 Neonatal Respiratory Distress Syndrome NRDS 28% [1] NRDS 10% NRDS [2] NRDS surface active material, SAM SAM SAM lamellar body LB [3] 1-5 m 5
6 [4] (Lecithin, L) (Sphingomyelin S) (phosphatidylinositol PI), (phosphatidylserine PS), (phosphatidylethanolamine PE), (phosphatidyl- glycerol PG) [4] 34 / (L/S ratio) 35 36 PG PI 35 LB 20~24 [5 6] L/S Lamellar body count,lbc NRDS hyaline membrane disease, HMD [7] 6
7 22~24 [7] NRDS 1971 Usher [8] NRDS <30 NRDS >60% 31~32 NRDS 35% 33~34 NRDS 20.5% 35~36 NRDS 5.4% >37 NRDS <1% [9] NRDS 10 11 NRDS 1922 20 50% 36 35~36 46% NRDS 7
8 NRDS 30~37%, 10~15% [12-14] 1970 37~38 L/S L/S NRDS :6.2% [15] Curet [16] Hallman [17] 1986 [18] 2 105mg% 120mg% 1986 Fadel [19] Gabbe [12] Curet [13] 1990 Kjos [20] 584 L/S PG 526 5 18 5 34 24 28 31 32 33 4 8
9 Piper [21] 1986 1 ~1992 1 L/S PG 829 289 PG + 540 PG + L/S >2 140 149 5 5.7 40 NRDS 8% 30/384 NRDS 6% 6/97 34 NRDS 29% 4/14 12% 25/207 [21-24] 1971 Gluck [25] L/S L/S 9
10 [26] Hagen 36 L/S 2 95% 32~35 84.2% 25~31 62.5% L/S 1972 Clements [27] Anceschi [28] 50% 86% 28% 95% 1976 Hallman [29] PG (PI) L/S <1,PG PI 0-2.5% L/S 2 PI 6.0-8.5% L/S >2 PG PI PG + L/S PG PI [30 31] PG 34 10
11 L/S 2 L/S 2 RDS PG L/S PG L/S Hallman [29] PG Tsai [32] Taos [33] [34] 1989 PG Golde [35] 35 78.1%PG(+) 40 10% PG Whittle [36] PG L/S 1992 Tsao [37] PG PG 1mmol/ml PG NRDS 1976 Sbarra [38] OD 11
12 Sbarra [38] [39] 400nm 450nm OD 400 650nm OD 650 L/S OD 650>0.15 1976 Shinitzky [40], [26 41 42] TDx FLM PC16 [41] NBD-PC [42] 1989 Dubin [43] LB LB 1-5 m LBC 12
13 LBC LBC Wijinberger [44] MEDLINE1966 1 1999 8 L/S LBC 6 6 NRDS ROC ROC LBC NRDS L/S 1 LBC NRDS NRDS NRDS NRDS TP FN FP TN / L % % Bowie [45] 56 1000g 5 7 1 13 35 20000 0.88 0.73 Ashwood [5] 247 400g 2 20 8 15 204 25000 0.71 0.93 Dalence [46] 130 276g 5 12 4 1 113 10000 0.75 0.99 Fakhoury [47] 28 500g 3 4 0 0 24 30000 1.00 1.00 Greenspoon [48] 62 7 0 6 49 46000 1.00 0.89 Lee [49] 157 500g 3 11 3 7 136 20000 0.79 0.95 1 LBC 2001 Neerhof [50] ROC 13
14 LBC 97.7%, L/S ratio 96.8% PG 94.7% p=0.048 Szallasi [51] Coulter Gen-S Beckman Coulter Sysmex XE-2100(Sysmex) ADVIA 120(Bayer Corporation) Cell-dyn 3500(Abbott Laboratories), [52] 1999 Coulter 450, 276g 5 LBC 25000/ L 100.0%, 91.2%, [53-55] 61.5%, 100.0% LBC LBC LBC 1971 Gluck [25] L/S 1973 Gluck [56] L/S White A B C L/S 36.5 2 35 2 1977 Gabbe [12] 1971 1 ~1976 6 210 14
15 L/S 200 L/S 2 10 L/S 1.5~1.9 133 36 3 L/S 2 L/S 200 RDS 3% 6/200, L/S 1.5~1.9 1 70% 7/10 RDS L/S [18,36,57-59] L/S 1972 Donald [59] 425 L/S 2 347 77 270 NRDS 3.7% L/S <2 NRDS 63% 30/48 L/S L/S 2 NRDS 7.4% NRDS 1.3% L/S Hallman [14] L/S Curet [13] L/S [61-63] L/S 15
16 Farrell [64] PC PC NRDS PG PC PC PC 50% [22-24] LBC L/S PG 1990 Kjos [20] 584 L/S PG 526 5 15% L/S 9% PG 3% OD650 1972 Liggin [65] NRDS 25.8% 9% 15% 3.2% Senat [66] Rotmensch [67] Noel [68] 33 477 9% 1cm 16